PROGNOSTIC FACTORS TO PREDICT OUTCOME FOLLOWING THE ADMINISTRATION OFHYPERTONIC HYPERONCOTIC SOLUTION, IN HYPOVOLEMIC PATIENTS/

Hypertonic solutions effectively improve hemodynamic parameters in pat ients admitted to the emergency room. However, no significant differen ces in outcome were observed compared with standard isotonic treatment in most previously published studies. This study evaluates pretreatme nt prognostic factors that predict a beneficial effect of hypertonic s olution in patients admitted to the emergency room with hemorrhagic hy povolemia in a prospective double-blind fashion. The patients (n=212) were randomized upon admission to receive 250 mL intravenous (i.v.) bo lus of hypertonic 7.5% NaCl+6% dextran (HSD, n=101), or isotonic 0.9% NaCl solutions (IS, n=111) as the first treatment, followed by standar d resuscitation. Pretreatment factors assessed were sex, age, cause of hypovolemia, revised trauma score (RTS), Glasgow index, and mean arte rial pressure (MAP) on admission. Both groups were compared for surviv al at 24 h and 30 days postadmission. Infused volumes were registered. HSD administration significantly increased MAP and reduced i.v. cryst alloid infusions to maintain hemodynamic parameters, compared with IS. There was no difference between groups in the number of blood transfu sions administered. Overall complication rates in both groups were sim ilar (24%). There was a significant difference (p <.03) in overall (30 days) survival rate between HSD (73%) and IS (64%) groups. The 24 h s urvival rate was significantly lower in IS (72%) compared with HSD (87 %); p <.01. Multivariate analyses showed that RTS and MAP were identif ied as independent predictors for 24 h survival in the group that rece ived HSD. When evaluated for overall survival rate, hypertonic infusio n benefited significantly only patients with MAP <70 mmHg (p <.01).